Journal of the Saudi Heart Association最新文献

{"title":"Cardiovascular Disease and Pregnancy: Clinical Outcomes From a Tertiary Center Experience in Saudi Arabia.","authors":"Nouf Alanazi, Sara M Abou Al-Saud, Wareef Almousa, Ghada Alshalan, Jumana Alqahtani, Munira Alsharif, Abrar Alshahrani, Hessah Alothman","doi":"10.37616/2212-5043.1465","DOIUrl":"https://doi.org/10.37616/2212-5043.1465","url":null,"abstract":"<p><p>Cardiovascular disease complicates pregnancy and elevates maternal and fetal risks. Local data in Saudi Arabia is scarce. This study examines pregnancy outcomes in women with cardiovascular disease at a tertiary center. A retrospective cohort study of 103 cardio-obstetric patients (2015-2023) at King Khalid University Hospital. Multivariable logistic regression identified risk factors for adverse maternal and neonatal outcomes, with significance at p < 0.05. The cohort (mean age = 35.5 ± 5.03 years, mean BMI = 31.33 ± 6.32 kg/m²) had high rates of hypertension (45.6 %) and preterm delivery (<37 weeks: 37/101, 36.6 %). Maternal hypertension occurred in 14.7 % (15/102). Neonatal outcomes included NICU admission (15.7 %, 16/102) and fetal loss (6.8 %, 7/103). Multivariable analysis revealed that a history of preeclampsia increased the odds of preterm birth (OR = 7.29, 95 % CI [2.16-24.63], p = 0.001), maternal hypertension (OR = 8.38, 95 % CI [1.90-36.97], p < 0.01), and NICU admission (OR = 6.98, 95 % CI [1.78-27.40], p < 0.01). Pre-existing diabetes (Types I/II) was associated with preterm birth (OR = 7.74, 95 % CI [1.70-35.24], p < 0.01). A higher BMI independently increased the odds of maternal hypertension (OR = 1.14 per unit, 95 % CI [1.01-1.28], p < 0.05). Bivariate analysis indicated that autoimmune disease increased the risk of low APGAR scores (0-6: 57.1 % vs. 11.1 %, p = 0.008), and prior cardiac procedures increased the risk of fetal loss (18.8 % vs. 4.6 %, p = 0.039). A history of preeclampsia, diabetes, and elevated BMI is a critical risk factor. Multidisciplinary preconception counseling and stringent antenatal monitoring are essential for this high-risk.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"37 4","pages":"13"},"PeriodicalIF":1.3,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12948628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Saudi Heart Association Position Statement on Adult Vaccinations for Patients With Cardiovascular Diseases.","authors":"Waleed Alhabeeb, Fayssal M Farahat, Majid M Alshamrani, Raed Aldahash, Mohamed S Al-Moamary, Mohammed Balghith, Yassmin Hanfi","doi":"10.37616/2212-5043.1461","DOIUrl":"https://doi.org/10.37616/2212-5043.1461","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular diseases (CVDs) remain the leading cause of mortality worldwide. Individuals with CVD are particularly vulnerable to severe complications from vaccine-preventable infections; however, adult vaccination continues to be underutilized.</p><p><strong>Methods: </strong>A multidisciplinary expert panel from the Saudi Heart Association (SHA) conducted a comprehensive literature review and a series of consensus meetings to develop evidence-based recommendations for adult immunization in patients with CVD.</p><p><strong>Results and conclusions: </strong>Evidence from randomized trials, observational studies, and real-world data supports the role of vaccines in reducing the risk of major adverse cardiovascular events in individuals with CVD. The SHA recommends the implementation of age-appropriate vaccinations against influenza, COVID-19, respiratory syncytial virus (RSV), herpes zoster, pneumococcal disease and meningococcal disease as an integral component of cardiovascular care. Recommendations emphasize routine vaccine assessment, integration into cardiology practice, healthcare provider engagement, patient education, and leveraging high-risk periods such as Hajj and Umrah for vaccination outreach.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"37 4","pages":"12"},"PeriodicalIF":1.3,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12948622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Chest Pain to Recovery: A Rare Case of Anomalous Origin of the Circumflex Artery From the Pulmonary Artery in a Child and the Role of Timely Surgical Intervention.","authors":"Alena V Kauk, Serezha N Manukian, Aleksey N Arkhipov, Alexey V Voitov, Ilya A Soynov","doi":"10.37616/2212-5043.1462","DOIUrl":"https://doi.org/10.37616/2212-5043.1462","url":null,"abstract":"<p><p>This report highlights the diagnostic challenges and successful surgical management in a symptomatic pediatric case with anomalous origin of the circumflex artery from the pulmonary artery. A 4-year-old boy presented emergently with dyspnea and substernal pain. Coronary angiography identified the circumflex artery originating anomalously from the right pulmonary artery. Emergency surgical reimplantation to the aorta was performed, with subsequent normalization of cardiac function (EF 67 % at 3-month follow-up). Although exceptionally rare, anomalous origin of the circumflex artery from the pulmonary artery requires high clinical suspicion in pediatric patients with ischemic symptoms. Early anatomical correction yields excellent outcomes, as demonstrated in this case.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"37 4","pages":"11"},"PeriodicalIF":1.3,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12991819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147474176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Dapagliflozin in Non-diabetic Acute Myocardial Infarction Patients Post-PCI: Effects on Cardiovascular Outcomes and Left Ventricular Remodeling (EARLY DAPA-AMI).","authors":"Hazem S E Salem, Ramzy M El-Mawardy, Mohamed E Zahran, Islam M Bastawy, Mina F Aziz, Abdelrahman E Attia","doi":"10.37616/2212-5043.1464","DOIUrl":"https://doi.org/10.37616/2212-5043.1464","url":null,"abstract":"<p><strong>Background: </strong>Early initiation of dapagliflozin, a sodium-glucose co-transporter-2 (SGLT2) inhibitor, may improve cardiovascular outcomes in acute myocardial infarction (AMI) by mitigating adverse remodeling and enhancing cardiac function.</p><p><strong>Objectives: </strong>To assess dapagliflozin's impact on major adverse cardiovascular events (MACE) and left ventricular (LV) recovery in non-diabetic AMI patients using speckle-tracking echocardiography (STE).</p><p><strong>Methods: </strong>This prospective, single-blinded randomized controlled trial (RCT) enrolled 200 non-diabetic patients with a first episode of AMI, including both ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI), following successful percutaneous coronary intervention (PCI). Participants received guideline-directed therapy and were randomized to dapagliflozin + standard care (Group I, n = 100) or standard care alone (Group II, n = 100). Echocardiographic parameters, including left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), LV end-diastolic volume (EDV), and LV end-systolic volume (ESV), were measured at baseline (1-3 days after acute myocardial infarction [AMI]) and at 6-month follow-up. Primary endpoint: 6-month MACE; secondary endpoints: cardiac function changes.</p><p><strong>Results: </strong>MACE rates showed no significant difference (Group I: 4 % vs. Group II: 9 %; p = 0.152). Group I demonstrated superior cardiac improvement: higher LVEF (52.24 % vs. 47.66 %; p = 0.025), greater ESV reduction (-7.41 ± 13.20 mL vs. -2.52 ± 9.17 mL; p = 0.003), and improved GLS (-14.50 ± 3.27 % vs. -13.48 ± 3.77 %; p = 0.043). GLS change was significantly greater in Group I (Δ-1.467 ± 3.023 % vs. Δ-0.475 ± 2.252%; p = 0.009). Hypertensive and chronic kidney disease (CKD) subgroups showed enhanced myocardial recovery with dapagliflozin.</p><p><strong>Conclusion: </strong>Early dapagliflozin in non-diabetic AMI patients did not reduce 6-month MACE but significantly improved LV function and remodeling, suggesting cardioprotective benefits beyond glycemic control, especially in high-risk subgroups.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"37 4","pages":"9"},"PeriodicalIF":1.3,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12991818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147474179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Focal Constrictive Pericarditis, an Unusual Cause for Biventricular Failure.","authors":"Farhan Parachikkottil, Harikishore Udhayan, Shijoy Parayil, Sajeer Kalathingathodika, Krishnakumar Prabhakaran, Kader Muneer","doi":"10.37616/2212-5043.1463","DOIUrl":"10.37616/2212-5043.1463","url":null,"abstract":"<p><p>A 34 year old male who had undergone surgical closure of a ventricular septal defect at the age of 4 years, after a long asymptomatic period, presented with heart failure and was diagnosed with atrial flutter and biventricular dysfunction. Chest X-ray showed a band-like calcification in the atrioventricular groove. Echocardiography revealed dilated atria, focal calcification with constriction at the atrioventricular groove, and biventricular systolic dysfunction. Focal constrictive pericarditis occurring in post-cardiac surgery patients is very rare. Here we report a case of focal variant of constrictive pericarditis manifesting in a young male after 3 decades of ventricular septal defect repair.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"37 4","pages":"1463"},"PeriodicalIF":1.3,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12604902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145505137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical Exercise Intervention Improves Cardiac Function and Reduce Recurrences in Non-permanent Atrial Fibrillation: A Systematic Review and Meta-analysis.","authors":"Editya Fukata, Rivaldo Hardani, Nabilah Mukti, Ferrisaga Pranawa, Fahmy Rusnanta, Ardian Rizal","doi":"10.37616/2212-5043.1459","DOIUrl":"10.37616/2212-5043.1459","url":null,"abstract":"<p><strong>Objectives: </strong>Evidences indicate positive effect of physical exercise on exercise capacity and quality of life in patients with AF. However, whether it improves cardiac function and reverse cardiac remodeling in AF patients was unknown. We aim to evaluate the effects of exercise intervention on cardiac function and structure, and the risk of AF recurrence in patients with non-permanent AF.</p><p><strong>Methods: </strong>A systematic review and meta-analysis was conducted following PRISMA guidelines. Searches were performed in PubMed, ProQuest, Google Scholar, ScienceDirect, and Scopus to identify randomized controlled trials (RCTs) comparing exercise interventions combined with standard AF treatment versus standard treatment alone in patients with non-permanent AF. The outcomes included changes in LVEF, left atrial indexed volume (LAVi), the E/e' ratio (early mitral inflow velocity/early diastolic mitral annular velocity), left ventricular end-diastolic diameter (LVDd), and the incidence of AF recurrence.</p><p><strong>Results: </strong>A total of ten RCTs involving 1013 participants met the inclusion criteria. The intervention group participated in supervised exercise sessions, with or without additional home-based exercise, alongside routine AF treatment. Exercise modalities varied, mostly included continuous or interval aerobic training ± strength training. The analysis revealed a significant increase in LVEF following exercise intervention (MD = 2.16 %, 95 % CI: 0.27 to 4.05, p = 0.03, I² = 74 %). However, no significant differences were observed in LAVi, LVDd, or the E/e' ratio. Interestingly, exercise intervention was associated with a reduced risk of AF recurrence compared to the control group (RR = 0.82, 95 % CI: 0.68 to 0.99, p = 0.04, I² = 33 %). Subgroup analysis revealed that interval training appears to offer greater benefit in reducing AF recurrence, while continous training results in greater improvement of LVEF.</p><p><strong>Conclusion: </strong>Exercise intervention improves LVEF and reduces AF recurrence, but does not affect cardiac remodeling. This effect is dependent on the type of exercise regimen.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"37 4","pages":"1459"},"PeriodicalIF":1.3,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12604903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145505078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound Evaluation of Left Ventricular Function in Coronary Artery Ectasia: The Added Value of 2D Speckle-tracking Echocardiography.","authors":"Osama A Elshaer, Mahmoud Gomaa, Ramy M Elgamal, Mohamed S Fahmy, Reda N Dawoud, Reda Biomy, Ahmed M Ahmed, Mohamed K Salama","doi":"10.37616/2212-5043.1457","DOIUrl":"10.37616/2212-5043.1457","url":null,"abstract":"<p><strong>Introduction: </strong>Coronary artery ectasia (CAE) is defined as abnormal dilatation of coronary arteries and may be linked to subclinical myocardial dysfunction. Conventional echocardiographic parameters may not adequately detect early left ventricular (LV) dysfunction. Two-dimensional speckle-tracking echocardiography (2D STE) has shown promise in identifying subtle myocardial changes.</p><p><strong>Methods: </strong>In this single-center observational study, 90 participants with available coronary angiography were divided into three groups: Group A (controls, n = 30), Group B (single-vessel CAE, n = 30), and Group C (multi-vessel CAE, n = 30). Standard echocardiographic indices including LV ejection fraction (LVEF), volumes, and diastolic function were assessed. Global radial, longitudinal, circumferential, and area strains were measured using 2D STE. Univariate and post-hoc analyses compared measurements across groups.</p><p><strong>Results: </strong>LVEF was preserved in all groups (p = 0.157), with conventional echocardiography detecting abnormalities only in multi-vessel CAE (Group C). In contrast, 2D STE revealed subclinical dysfunction in both CAE groups. GLS declined from -20.4 % (controls) to -17.3 % (single-vessel) and -14.6 % (multi-vessel; p < 0.001). GCS and GRS followed similar patterns.</p><p><strong>Conclusions: </strong>2D STE detected subclinical LV impairment in early CAE, whereas conventional methods revealed dysfunction only in advanced disease. This supports the value of 2D STE for early monitoring in CAE patients.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"37 4","pages":"1457"},"PeriodicalIF":1.3,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12537021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145345922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infective Endocarditis and Meningitis in a Healthy Newborn Without Underlying Heart Disease, Due to Streptococcus <i>Agalactiae</i>-A Case Report.","authors":"Dalal S Idris, Muath M Al Ghamdi, Maria L Bello Valls, Mohammed Fararjeh","doi":"10.37616/2212-5043.1453","DOIUrl":"10.37616/2212-5043.1453","url":null,"abstract":"<p><p>Streptococcus <i>Agalactiae</i> endocarditis is a rare clinical entity in newborns with a normal structured heart. It is generally characterized by acute onset, the presence of large vegetations, rapid valvular destruction and frequent complications, particularly embolization. Mortality is high with medical therapy alone. We are reporting a rare case of infective endocarditis (IE) with mitral valve vegetation in a 9 days old healthy newborn following Streptococcus Agalactiae sepsis, complicated by meningitis and micro-abscesses. Mitral valve (MV) vegetation was removed surgically; the patient received intravenous antibiotics for six weeks. Transthoracic echocardiography after surgery showed severe MV regurgitation and severe pulmonary hypertension which was successfully managed by conservative care with cardiac medications.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"37 4","pages":"1453"},"PeriodicalIF":1.3,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12537023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145345892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous Thromboaspiration of Left Main Coronary Artery Vegetation in a Patient With Aortic Valve Infective Endocarditis and Acute Coronary Syndrome.","authors":"Matthew B Morton, Jeremy Russo, Malanka Lankaputhra, Christopher Merry, Dion Stub","doi":"10.37616/2212-5043.1456","DOIUrl":"10.37616/2212-5043.1456","url":null,"abstract":"<p><p>Acute myocardial infarction from a vegetation is a rare complication of infective endocarditis. Thrombolysis, percutaneous coronary intervention with balloon angioplasty, stenting, and thromboaspiration, and surgery have all been described in this challenging clinical scenario. A woman with staphylococcal bioprosthetic aortic valve infective endocarditis developed acute myocardial infarction due to a vegetation invading the left main coronary artery, which was successfully managed with percutaneous thromboaspiration.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"37 4","pages":"1456"},"PeriodicalIF":1.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12537022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145345936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilization of Critical Care U/S Imaging Tools for Assessment of Cardio-pulmonary Complications in Extracorporeal Circulatory Support in Patients Post Cardiac Surgery and ECMO.","authors":"Mohamed A Ragab, Suzi F Mikhael, Amr E Elhadidy, Ihab A Abdelmoneim, Khaled A Al Faraidy, Abdulrahman I Alhusil, Mohsen S Abdelazeem, Abdelraouf Fahmy, Sarah H Yacoub, Fathia A Samter","doi":"10.37616/2212-5043.1454","DOIUrl":"10.37616/2212-5043.1454","url":null,"abstract":"<p><strong>Background: </strong>Extracorporeal life support (ECLS), including extracorporeal membrane oxygenation (ECMO), is increasingly used in patients post-cardiac surgery. However, cardiopulmonary complications and delayed weaning remain common.</p><p><strong>Objectives: </strong>This study aims to investigate the clinical course of post-cardiac surgery and extracorporeal membrane oxygenation patients using lung ultrasound and echocardiography.</p><p><strong>Patient and methods: </strong>This prospective multicenter observational study was conducted in the intensive care units of King Fahd Military Medical Complex, Saudi Arabia, and Cairo University, Egypt. A total of 103 adult patients requiring ECMO or post-cardiac surgery with cardiopulmonary bypass were enrolled.</p><p><strong>Result: </strong>Postoperative echocardiographic assessment showed significant reductions in EF, TAPSE, and VTI, with increased VTI variability. Extubation time correlated significantly with EF, LVESD, LA diameter, and postoperative VTI variability. Diaphragmatic ultrasound revealed reduced excursion and thickness fraction postoperatively, both strongly associated with prolonged ventilation. LUS detected atelectasis, pleural effusions, and diaphragmatic dysfunction earlier than conventional imaging.</p><p><strong>Conclusion: </strong>CCUS is a valuable bedside tool in post-cardiac surgery and ECMO patients. Echocardiographic parameters (EF, LVESD, and VTI variability) and diaphragmatic function indices are strong predictors of weaning success, while LUS facilitates early pulmonary complication detection. Incorporating CCUS into routine monitoring may enhance patient outcomes and optimize weaning strategies.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"37 4","pages":"1454"},"PeriodicalIF":1.3,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12558655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145390708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}